States reporting on HIE enrollments, adjust future plans, as insurers plan rate increases

Now that the enrollment period is over for the health insurance exchanges (HIEs), individual states are reporting their enrollment figures; some states report meeting their enrollment goals and others falling far short. Beyond a simple exercise in tallying, state leaders are also evaluating their state’s exchange rollout successes, challenges and enrollment demographics, making plans to address gaps in enrollment and devising operational tactics for the coming year. At the same time, major insurers, such as Aetna and United Health Group, are beginning to report their first quarter results under the new health care law and offer some indication about rate hikes next year.

Official Tallying and Gap Analysis: Nevada

The Obama administration is reporting having successfully met its enrollment goal of more than 7 million individuals who signed up for health insurance under the new HIE plans. Each state was also hoping to meet its individual enrollment goal as well.

Nevada, for example, came in with underwhelming enrollments, according to an article in the Las Vegas Review-Journal. Without much analysis needed, state leaders could see that the state’s Hispanic population was particularly underrepresented in the final tally. Hispanic enrollees made up 17.8 percent of enrollment in private, qualified health plans through Nevada Health Link, the state’s insurance exchange. The number is particularly disappointing considering that Hispanics make up 43 percent of Nevada’s 600,000 uninsured, according to the article.

Unravelling the reasons behind the low Hispanic enrollment is complicated, and could be attributed to variables such as simple reporting, not seeing the need to purchase insurance since they didn’t have it before, and finally, cost. An individual plan for a younger enrollee would have cost $89 a month and a maximum of $2,000 out of pocket in 2013. That jumped to $200 a month and out-of-pocket costs of as much as $6,250 in 2014, according to the article.

Should We Stay or Should We Go?

All of the states are conducting analyses of their participation in HIE plans, whether they are state run or run by Healthcare.gov. Of the 36 states that relied on HealthCare.gov for this year’s enrollment, only Idaho and New Mexico plan to switch to state-run marketplaces for the next open enrollment period.

Oregon has received a lot of notoriety for deciding to go the opposite way, making the decision to give up on its state-run exchange and use the federal system from now on. The online state program has been plagued with problems since the start and even had to use a hybrid online and paper-based enrollment system to get people enrolled. State officials estimate that fixing it would be too costly at $78 million and would take too long. Switching to the federal system will cost $4 million to $6 million.

One article in the Seattle Times reported that 400 workers were hired to aid in the manual enrollment effort, despite the $134 million Oregon paid to its technology contractor Oracle to build the online exchange.

Financial Impact: Insurers and HIE Enrollees

Finances also are top of mind for insurers when it comes to carrying out coverage under the new health law. Major health insurers are reporting their first quarter of financial results under the new market rules, offering a little perspective on how they’ve been affected by the law and what their next move might be.

Aetna Chief Executive Mark Bertolini reported the company's first quarter results under the Affordable Care Act. Aetna participates on exchanges in 17 states and Bertolini reported that to-date, the company has added 600,000 enrollees from health insurance exchanges, and that 500,000 of those enrollees have paid premiums. Based on demographic data collected so far, enrollee’s average age is coming in higher than we priced for, Bertolini said in an interview on CNBC.

Regarding rate increases, Bertolini said Aetna does plan rate increases for next year across the 17 exchanges in which it participates, and those increases will range from "the very low single digits" to "some that will be over double digits." That depends on the number of members, the demographics of memberships and what limited information the company has about new members.

He also said that about half of the company's premium increases, whatever they turn out to be, will be attributable to "on the fly" regulatory changes made by the Obama administration. He cited as an example the administration's policy of allowing old health plans that were supposed to expire in 2014 to be extended another three years if states and insurers prefer.